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General NPI Number Information
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NPI Number | 1073928396
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Entity Type | Individual
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Provider Name | ANASTASIYA HUBERTY
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Gender | Female
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 1055 WESTGATE DR
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City | SAINT PAUL
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State | MN
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Zip | 55114-1065
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Country | US
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Telephone | 651-955-7537
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 WEDGEWOOD DR
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City | EAGAN
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State | MN
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Zip | 55123-1934
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Country | US
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Telephone | 651-955-7537
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AG0614089
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License Number State | MN
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